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Permit No.
<br /> APPLICATION FOR SANITATION PERMIT
<br /> {(Complete in Duplicate)
<br /> _ ate Issu__edrt . /?Asort-:. tApplication is herer-774777=7 =7777717-7:
<br /> by made fo the San Joaqu}n-_Local Health 6isfrict for a permit to construct arid install tie work herein desribed.
<br /> This application is made in compliance ''urith County,.Or .finance No; 549.
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<br /> AJOB ADQRESS AG�I]�LOCAT N .`. s "".._.. _.--------- _ '
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<br /> Owners •N8 _ ._Yui--- - ��:..`m-Y:.:::, �w,:- -•-- -w - ._.:_ � "# - ., ,.,_,.,..�:;-� t ,..-,.----------------
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<br /> Address ;M
<br /> -•- T -�.. d - --r--• -,----•- ----_ . ----------------------------------, ; --------- -- --- _ -.
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<br /> Contractor s__Name_: -"r ►� V_ ---------------------' Phone
<br /> Instalia#ram will'serve: Residence A artrnent House Commercial -❑ Traller-Court ❑ Mo �1 ❑ Other j] i
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<br /> Number'of living units: �__:_ Number of bedrooms ./Sl:_ Number of baths Lot size __. '__ ,t`4__r !. ---------------.----.-
<br /> Wate -Supply:"'Pulalic system ❑ ":Community systew;[]"PrivateLLL Depth to Water Table _"ft_—"_!
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<br /> ___ . ft �.
<br /> } o a de "th_of_3 feet:~.Sand Gravel ❑- Sandy Loam ' clay'-Loam ❑ Clay � ,.Adobe Hardpan ❑
<br /> Character.of soil t p
<br /> Previous Application'hilade: Yes []' 'No New Construction:' Ye's No ❑
<br /> TYPE OF F INSTA' ATION AND SPECIFICATIONS < i
<br /> available wlthin:200 feet ,,: ! ;:
<br /> -( septic- r rt p P _
<br /> P ttede�f ub�hc se Distanis from� dati n Ma#er'al -
<br /> No tank,-or,cess ool ermi
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<br /> r 9 ' <, _ - f --;---
<br /> �.�..K. i S ' E i uad. e th : '' ``.------ Capacity �¢
<br /> Se tic ank' I Dotaof compartments .._ x __. ____ --------� '- q • P ; " � � )
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<br /> '' i + P ndation-_ _ _: ehnceto nearest-lot line__'_ 3----pield: Distance from nearest a€1t�Q. Distance from fou
<br /> ' Number. of: lines____- �._ -,',--',,Length, of each line-_: .���a_dWidth'of tr=ench.---,.,__:_ - "`--
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<br /> r r Type of filter mater`il � p
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<br /> } r YPpth of filter material i{_ -Total len th '------------/___ _
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<br /> Seepage-.Rit': .,Distance to nearest•well ,__.. _ _- Distance from foundatton____;_ ___....Q�starice to nearest lot line_____'
<br /> 0 ` ' » Number of pits.- ---------Lining material._-_ - '---_-- --.Size. Diameter_ -- ::'-,_,De th B --------
<br /> 9 .t ,p
<br /> Cesspool. * , Di�to D ameter nea st well '__.---- K�
<br /> $ isfa ce from fundatlon___i . Lining
<br /> i�nufd Capac
<br /> Y Size. Depth. _A ;. ;. k q} > , �tY 1 :_ gals.
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<br /> _ f' I. "' `•-- . _ ._Distance from nearest buildiri
<br /> Privy:. r. Distance I ram nearest well---.-, -•---- -- ---•---- --------- - ----------------------------------------
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<br /> F1_.,. ,,..�,..�», ., .n rest.lot line ----- ,�..�_...�__� .�,.,-•i - •----- - --------------. :-------- •- ------------ --------
<br /> ' Qrstance to ea �
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<br /> 1� Ll£5 '--- --- ---• --- -— -
<br /> emokd�liln an, epairingl( &ibe] r f
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<br /> I'hereby certify that I have°preparled this application and that the'work will-be done•in accordance with San Joaquin,County
<br /> ordinances, State-laws.' and ules nd re ulations of the San Joaquin Local Health,District. 1 Y
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<br /> --------- - -------- ------- -- ---------------- ti----- - ---,------- ---(Owner and/or Con attar]
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<br /> (Plot plan,°showing size of.lot,location of system in rela lion.to wells, buildings, etc.; can a placed.on:reverse side}:
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED-BY _- ' l ---- ------- ( - D ------------------------- --------
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<br /> REVIEWED BY - r .` - = DATE.: - --} - ------'----------------
<br /> # .. #. ,. . = DATE.. RA---- -------------------
<br /> BUILDINGI
<br /> PERMIT ISSUED_ - l -------------------------- -- ---(------- -
<br /> Alterations and/or.recommendations _ - ...;. --•-- —-- = `
<br /> I : # I i ,'. -- --- --- ----------- ' ------------- ------•--- --------
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<br /> FINAL INSPECTION-BY:"'---:.'"`-` ------- -- ---- --- --- --- - ------------ a e::"tl ----------.......,.'.---------- -- ----------------------
<br /> SAN
<br /> ----=------------ -SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street 300 Wes} Oak Street 132 Sycamore Street 814 North "C" Street
<br /> Stockton, California Lodi, California Manteca, California Tracy, California
<br /> F: --1—•lM 145446 ATW"-- 12-54
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